July 20, 2020

MEETING ANNOUNCEMENT

Hawaii Medical Education Council

Monday, July 20, 2020

7:30-8:30 am

 

Due to COVID-19 precautions, and in observance of social distancing, this meeting will be held via Zoom 

 

Please contact Crystal Costa via costaca@hawaii.edu or 

(808) 692-0989 for Zoom meeting access 

 

If you need an auxiliary aid/service or other accommodation due to a disability, contact Crystal Costa at 808-692-0989 or via email at costaca@hawaii.edu preferably by July 17, 2020, 12:00 PM.  Responses received after that may not be guaranteed though we will try our best. Upon request, this notice is available in alternate formats such as large print, Braille, or electronic copy.

 

AGENDA

                           Hawai‘i Medical Education Council (HMEC)                                              University of Hawai‘i, John A. Burns School of Medicine                              Date: Monday, July 20, 2020, 7:30 a.m. – 8:30 a.m.                                           Via Zoom – Due to COVID-19 precautions

  1. Review & Approval of April 27, 2020 Minutes –Dr. Hedges (distributed via email to members on 7/17/20)
  2. Report from HMEC Chair – Dr. Hedges a.Announcements/Discussion (10 minutes)                                                             i. Impacts and adjustments due to COVID-19                                              ii.Graduate Medical Education updates – Lee Buenconsejo-Lum                                                                                                                                           b. Update on Legislative Strategies – Jerris Hedges and Cynthia Nakamura (15 minutes)                                                                                                        i. Maui                                                                                                                                    ii. Senate Resolution 191 (Hamakua/Kohala)                                        c. Family Medicine Clinic opening at Pali Momi Outpatient Center (5 minutes)                                                                                                                  iii. Virtual tour
  3. Physician Workforce Data Updates & Synergies – Aimee Grace & Kelley Withy (20 minutes)                                                                                            a. Preceptor Tax Credit Update                                                                               b. Physician Workforce       
  4. HMEC Recommendations as proposed to the 2020 Legislature – Lee Buenconsejo-Lum (5 minutes)

RECOMMENDATION #3                                                                                      UH/HMEC recommends that the 2020 State Department of Human Services and other stakeholders explore the mechanisms to obtain Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.

5. Additional Items                                                                                                                             a. Announcements – Next HMEC Meeting –                                      Monday, October 26, 2020 @ 7:30am in MEB 202

6.  Adjournment 

MINUTES

Hawai‘i Medical Education Council (HMEC) Meeting                                                    July 20, 2020  Time:  7:30-8:30 am                                                         John A. Burns School of Medicine, via Zoom due to COVI19

Members Present:            Lee Buenconsejo-Lum (Associate Dean for Academic Affairs, Designated Institutional Official (DIO) for Graduate Medical Education, JABSOM), Katherine Finn Davis (for Mary Boland, representing the School of Nursing), Jami Fukui (for Randall Holcombe, representing the UH Cancer Center), Jerris Hedges (Chair, JABSOM Dean), Allen ”Chip” Hixon (representing the health professions community), Kenneth Robbins, (representing a hospital conducting ACGME programs), Kathryn Ryder (representing the federal healthcare sector), Todd Seto (representing a hospital conducting ACGME programs), and Joseph Sterbis (representing a hospital conducting ACGME programs) and Sharon Vitousek via Zoom (representing health professions community).

Members Absent:             Lorrin Kim (for Bruce Anderson, representing the Department of Health) and Lisa Rantz (representing a person of the general public).

Others in Attendance:     Mary Ann Antonelli (Medical Education Director, VA), Patricia Blanchette (Interim Associate Dean for Clinical Affairs, JABSOM), Chip Ellis (CFO, University Health Partners of Hawai‘i), Aimee Grace (UH Director of Health Science Policy), Marlene Keawe (COO, Hawai‘i Residency Programs, Inc.), Cynthia Nakamura (Government Affairs and Legislative Consultant), Holly Olson (Deputy DIO, JABSOM), Linda Rosen (CEO, Hawai‘i Health Systems Corporation), Larry Shapiro (CEO, University Health Partners of Hawai‘i), Susan Steinemann (Assistant DIO, JABSOM) and Kelley Withy (Director, AHEC).

HMEC Administrator:         Lee Buenconsejo-Lum        Recorder:              Crystal Costa

TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS 
1. Review of MinutesMinutes from our last meeting, held on 4/27/20, were reviewed and approved with edits to correct the legislative strategies year from 2019 to 2020. The motion to approve came from Dr. Hixon and second by Dr. Vitousek. Approval was unanimous. No opposed and no abstentions.NA.
2. Chair Report Dean J. Hedges & Legislative Strategies Update by Cynthia Nakamuraa. Announcements (Dean Hedges) Impacts and adjustment due to COVID-19:
Dean Hedges thanked everyone and appreciated the collective efforts and progress being done to address the pandemic. JABSOM has been on the cutting edge of changes and implementing procedures for the reopening of educational services while continuing to develop approaches that maintain high standards and minimize exposures. Staff, faculty, students, and operations continue adjusting to various conditions with many working from home full- or part-time. The UH Mānoa main campus is also implementing hybrid learning and work strategies, addressing quarantine issues, and is in the process of developing a health monitoring app to check the status of all coming onto a UH campus. UH and the app developers are working to address concerns about privacy and data usage. JABSOM and UH Mānoa continue to comply with and closely monitor state and federal guidelines.
JABSOM Medical School AAMC Rankings:
The US News & World Report "ranking" of medical schools is subjective and based upon name recognition (by deans or program directors) in the US. By comparison, the AAMC annually collects objective data from medical schools (including from students’ actual perception of their education) analyzes it by region, size of school and type of school (i.e., community-based medical school). For the following key metrics, JABSOM ranks greater than X% of medical schools: 75% for proportion practicing in primary care, 55% for proportion practicing in the state, and 100% for Native Hawaiian Pacific Islander populations. Despite this, there is an opportunity to enhance the numbers of Native Hawaiian students so that the proportion matriculating into medical school reflects the proportional distribution of Native Hawaiians in the State. JABSOM takes great pride in being ranked 91%ile of the proportion of faculty who are women. Ranking of students’ perceived quality of clerkships were above 50% and the overall satisfaction with the quality of education is high at 97%.
JABSOM ranks 99% in preparation to care for diverse populations, 89% plan to care for the underserved, and 98% with experience with cultural awareness/competence, but we continue to focus on related areas where we need to enhance our efforts. Notably, the average medical school debt is 56% greater than other medical schools, but the average increase was high (99%) compared to prior years.
Though a smaller school, JABSOM remains a vital professional school serving Hawai‘i and has been successful in its commitment to training a diverse student body. More remains to be done for the Native Hawaiian, Pacific Islander, and Filipino candidates. JABSOM students understand the quality of their education and recognize their preparation to care for diverse populations and the need to address health disparities. The success of training and retaining primary care providers is at risk due to several factors, one being the growing medical student debt. JABSOM is thankful and applauds the physician workforce and scholarship efforts that are continuing.
Graduate Medical Education Updates (Dr. Lee Buenconsejo-Lum):
Due to the pandemic, this year’s annual graduation and white coat celebrations were modified. Fortunately, all residents and fellows were still able to graduate on time.
NA.
Informational only. Ongoing updates.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
Regardless of the pandemic status at the institution and in the community, the ACGME requires strict adherence to the GME programs having proper PPE, resources, training, adequate supervision, and work hour requirements. Duty hours are monitored closely. Changes to orientation, rounding, areas for charting and clinical teaching are occurring to allow for as much physical distancing as possible.
Programs are working diligently to be as flexible as they can while aiming to provide the best educational experience possible.
Academic Year 2020-2021
As of June 2020, Hawai‘i is in the “Act with Care” stage of reopening and continues to monitor surge plans, maintain the usual processes to ensure continued accreditation. Educational lectures are mainly held virtually. Telemedicine services in some programs are 50-85%. Individual residents/fellows that are high risk or live with someone who is high risk for developing severe COVID-19 should discuss their options with the Program Director. Large group meetings and trainings continue to be delivered online. Away rotations have been limited by the AAMC and ACGME. This year’s recruitment season will be completely online. For incoming residents, the onset of recruitment will be delayed a month to account for nation-wide delays in taking the USMLE Step 2 examination, as well as deferred clinical rotations given the sheer number of schools where students were unable to participate in clinical training for more than a month.
The interprofessional root cause analysis simulation between JABSOM, Nursing, and Pharmacy was converted to a purely online format in April 2020 and received positive reviews despite the pivot. The session will be offered again in the Spring of 2021. JABSOM is developing a coordinated structure to address systemic racism in medical education and continues to strengthen efforts toward improving diversity, equity, and inclusion.
Well-being and resilience will remain a major focus in the new normal of physical distancing, uncertainty, and frequent change. This is an opportunity to deal with uncertainty in a positive way.
Family Medicine Clinic Opening at Pali Momi Outpatient Center (Dr. Allen Hixon)
The Family Medicine program has been transitioning away from Wahiawa General Hospital as the major inpatient clinical training site to Pali Momi Medical Center. The final transition piece was to relocate the primary ambulatory training site (residency/faculty clinic) to the Pali Momi Outpatient Center. The legislature provided $1M to help with this, with the remainder of support coming from UHP and HPH. Additionally, the residency program temporarily increased their class size from 18 to 21 residents, with the hope of making this size permanent. The new clinic opened in June 2020, which includes the ACGME-required residency education space, faculty, and Department staff offices. The clinic’s proximity to Pali Momi Medical Center allows for more efficient care between the inpatient and outpatient setting, as well as between Family Medicine and OB because the OB faculty clinic is also in the same Outpatient Center.
Residents and faculty will continue to work in a team-based care model that includes integrated behavioral health, pharmacy, and patient navigation services with an emphasis on high quality, cost-effective primary care of all ages of patients.
b. Legislative strategies update for 2020, JABSOM’S Priorities (Cynthia Nakamura):
The legislature went into recess on March 16, 2020, due to COVID-19, and briefly reconvened on May 11 and June 22, 2020. The 2020 legislative session finally adjourned on July 10, 2020. The main focus of the legislature was to address the fiscal shortfalls stemming from
the pandemic. The budget which was passed this year reflects funding levels from FY 2019 – 2020. Any supplemental requests for appropriations were not funded.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
Despite favorable legislative support, JABSOM’s funding request of $1.4 million for the expansion of medical education and training to Maui was not approved because of the change in the state’s fiscal outlook due to COVID-19. Discussions will continue with Maui to see where opportunities and resources exist to offer clinical rotations.
Not passed: SB 2983 which sought state matching funds of $500,000 for the loan repayment program
Not passed: SB 2392 that would have provided funds to support student stipends for those enrolled in the `Imi Ho‘ōla program and HB 2188 which requested that JABSOM conduct a study on the effect of noise generated by wind turbines on nearby residents and provided funding for the study.
Not passed: SB 31 relating to the preceptor tax credit which sought amendments to the definitions of “primary care providers”, “volunteer-based supervised clinical training rotation” and “compensation”.
Passed: HB 2340 relating to dead bodies which clarified prohibited actions related to anatomical gifts and disposition of bodies. Although not one of JABSOM’s priorities, the measure is helpful to the willed body program.
SR 191 recognized and supported ongoing collaborative efforts to produce a rural health care delivery hub plan to address the physician shortage and improve health care in rural areas. The scheduled hearing was cancelled due to COVID. The resolution would have been to consider developing a teaching clinic in the North Kohala area (Hamakua/Kohala) on Hawai‘i Island.
3. HMEC Recommendations to 2020 Legislature
L. Buenconsejo- Lum
RECOMMENDATION #3
UH/HMEC recommends that the 2020 State Department of Human Services and other stakeholders explore the mechanisms to obtain Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.
Continued Work Needed to Stabilize & Expand GME
Dean Hedges and Dr. Buenconsejo-Lum met with Judy Mohr Peterson, Medicaid Director for the Hawai‘i State Department of Human
Services, to discuss the impacts on GME as many residents take care of Medicaid beneficiaries and those in foster homes. Medicaid is
willing to discuss the issues at a later date as their priorities and current efforts are focused on addressing their recently rescinded
request-for-proposal to fit a drastically and rapidly changing economy.
The need to diversify faculty funding resources remains a high priority as the University anticipates continued hiring freezes and potential
budget reductions. One strategy includes maximizing resources and identifying synergistic opportunities with the VA and TAMC for
educational experiences.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
4. Physician
Workforce Data Updates & Synergies
Dr. Kelley Withy + Dr. Aimee Grace
Telehealth (Dr. Kelley Withy)
Over the years, telemedicine has been increasing in awareness (2015 – 2%, 2017 – 15%, December 2019 – 24%) with an expected increase in demand due to COVID-19. AHEC has partnered with Rear Admiral Louis Tripoli (US INDOPACOM) to develop a telehealth curriculum for students of different levels with the first training sessions expected to begin in August for the rural health interest group. AHEC also works with the Pacific Basin Telehealth Resource Center (PBTRC) that is working to develop best practices, training, and resources.
Loan Repayment Program and Preceptor Tax Credit (Dr. Kelley Withy)
The state loan repayment program did not get renewed by the legislature and therefore will not be honoring any new applications. Because the program needs to find $300K to match the federal funds, the focus will be to maintain funding for those currently enrolled in the program. Funding ideas include a recent grant submission through nursing for $25K, funds from the physician workforce budget, Hilo Medical Center, and the Barry Taniguchi Medical Subsidy Program. They will continue searching for more opportunities.
While the preceptor tax credit bill did not pass, JABSOM will continue to work with the legislature to better define the terms and provider base eligible for the credit. Upon review of the first year in operation, 8 errors were found that resulted in $5K being issued to preceptors categorized incorrectly.
Other Updates (Dr. Kelley Withy):
On the workforce front, research volunteers and premed students have been making phone calls and created a new category in the physician workforce database to include, “not working during COVID-19”. This report should be ready by the end of Summer. The initial findings show that many providers are not working during COVID-19.
AHEC has been working with HIEMA which obtained $100M from the CARES Act funds to be used for PPE. AHEC is developing a website where PPE can be ordered. Information will be released over the next few weeks with details on how to order and quantities allowed. This website will not be limited to medical professions and will be open to schools and small businesses. Although orders will be filled with current supplies, it could take up to 2 months to receive materials.
The annual Workforce Summit will be held completely virtual and intended to be interactive on Saturday, September 12, 2020.
HIEMA Updates (Dr. Aimee Grace)
HIEMA is working on a statewide telehealth needs assessment which currently includes 105 responses. Questions in the assessment includes asking about synchronous audio and visual services (e.g., were you offering these services pre-COVID, during COVID, or do you desire to offer these services; what type of services are being offered). Responses include public and private hospitals, FQHCs, private practices, and more. Currently, data is still being collected and information is proprietary at this time and not for distribution. The Pacific Basin Telehealth Resource Center continues to be available to provide services. The purpose of this assessment is to identify where the gaps are in the State’s capacity to provide telehealth. The breakdown will be by county and facility type to help best allocate resources and services where they are needed.
Federal Appropriations FY 2021 Bills Update:
Ongoing updates to be provided by Dr. Withy and Dr. Grace.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
The House has been releasing its subcommittee bills which have been illustrating many of our initiatives coming together. While it is good to get funding, it is also good to get helpful “report language” which directs how federal funding should be spent. Themes that are emerging include the contribution of Native Hawaiians and Pacific Islanders to the military and encouraging the VA to create centers that are dedicated to these specific populations, partnering with non-government organizations and universities to examine telehealth services, models of interprofessional primary care, electronic health records, workforce and indigenous innovations.
In the Labor, Health and Human Services, Education, and Related Agencies subcommittee bill, the push is for a Center for Indigenous Innovation and Health Equity that has $2M in the budget. UH is trying to remain as competitive as possible and has partnered with the University of Oklahoma. Together we will keep advocating and are considering providing an appropriations workshop for JABSOM to help educate on the appropriations process.
5. Additional Items All participants present for the duration of the meeting.
 Next HMEC meeting: Monday, October 26, 2020, at 7:30 am, location TBD.
6. Adjournment Meeting adjourned by Dean Hedges at 8:36 am.
Minutes Approved:                                                                             (Recorders Initials & Date)